The Mystery of Ezra Klein

The Education of Ezra Klein (and Barack Obama) continues: In 2007, Young Ezra Klein was full of enthusiasm about the cost-saving potential of electronic record keeping in the health industry. The failure to rapidly adopt this new technology was nothing less than an indictment of the American Way of Medicine:

I’ve never read a compelling explanation of why the nation’s doctors and hospitals haven’t broadly adopted electronic medical records. It’s not as if they’re allergic to technology. At this point, cardiovascular care employs every strategy but astral projection to keep our [hearts] in rhythm. It’s not as if it wouldn’t be cheaper and easier for them. …

That all these factors haven’t spurred our private providers to incorporate such broadly appreciated technology should be one of our first signs that American medicine is not responding to the incentives we’d expect.

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records — a computer-based system that would contain every patient’s clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

There’s an argument that we’re eventually going to look back at the stimulus bill’s investment in electronic medical records as the most important improvement the Obama administration made to the health-care delivery system — and, if the more optimistic assessments are right, as a crucial piece of infrastructure that allowed us to eventually get costs under control.

Comes now the RAND corporation to tell us that the projected cost-saving benefits of electronic medical records have not materialized. From the NYT‘s report:

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

It turns out that electronic records allow hospitals to easily “upcode” procedures, charging more for them, while removing some of the hassle of ordering expensive tests. As Groopman and Hartzband note, the most common kind of costly medical error is misdiagnosis–and those misdiagnoses are now spread far and wide at the speed of electricity rather than carbon paper. Doctors may also be discovering something Microsoft employees discovered long ago: computers allow the exponential proliferation of bureaucratic paperwork. You don’t even need the paper.

The larger American health-care system isn’t even in a position yet to figure out whether cost savings are possible …

What are we to make, then, of Klein’s confident enthusiasm in 2010 and earlier? Did he really believe it? I assume he did (in the sense that he wasn’t cynically BSing). But why? Was it a) the result of a continuing process of investigation in which he confronted the best arguments against the idea or b) something some expert (not Groopman!) told him or c) a convenient belief because it plugged a political hole for Democrats, allowing Obama and his supporters to pretend that universal health care coverage was going to be a lot cheaper than people thought (thanks to the cost-saving bonanza of electronic records)? If a belief satisfies criterion (c), does Klein even really care if it satisfies (a)?

This is the epistemological mystery of Ezra Klein. It’s not a mystery for most journalists–they claim to be playing Game (a). If they fall short, that’s highly embarrassing for them. It’s not a mystery for President Obama–he’s a politician who wanted to pass a universal health insurance coverage plan. He’s playing Game (c). If a theory like “green jobs” or “electronic medical record savings” plugs a political hole for him, he’s going to go for it (having probably concluded that even if, say, electronic medical record savings turn out not to be real, the country’s still better off with greater Obamacare coverage). Klein poses as a “wonk,” indicating he may think he’s playing Game (a), but his history on the electronic records issue suggests that if he is he’s deluding himself–and his readers.

Hoaxer, self-hoaxer, or just confused? When they are through with Manti Te’o maybe the nation’s amateur detectives can turn to Klein.